Provider Demographics
NPI:1689946295
Name:DENNIS, CECILIA
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 811
Mailing Address - Street 2:
Mailing Address - City:TOBYHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18466-0811
Mailing Address - Country:US
Mailing Address - Phone:570-656-3660
Mailing Address - Fax:570-504-5912
Practice Address - Street 1:8616 COUNTRY PLACE DR
Practice Address - Street 2:
Practice Address - City:TOBYHANNA
Practice Address - State:PA
Practice Address - Zip Code:18466-3362
Practice Address - Country:US
Practice Address - Phone:570-656-3660
Practice Address - Fax:570-504-5913
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No172V00000XOther Service ProvidersCommunity Health Worker